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        <p>原来2019锐读会的课程还没完，还有一本书。那就继续。时间改到周四晚上了。两周开一次课。<br>第一部分：RBFDPS的概述<br>1.什么是RBFDPS？<br>a.Resin-Bonded Fixed Dental Prostheses的缩写<br>b.树脂粘接式固定桥<br>2.其应用已有历史<br>3.2016年德国将金属RBFDPS修复单颗牙纳入医保<br>4.RBFDPS发展缓慢的原因是牙医对粘接的未知。<br>第二部分 历史演变<br>第一节：起源<br>1.前牙缺失后的临时替代方案。<br>2.IPT技术（即刻桥技术）<br>a.拔牙后截去牙根（进入拔牙窝2-3mm）<br>b.酸蚀粘接充填根管后断面磨成卵圆形抛光<br>c.酸蚀离体牙和邻牙分别涂布粘接剂。<br>d.将离体牙用树脂固定到原位后固化。<br>e.舌侧聚乙烯纤维网固定（调颌）<br>第二节 诞生<br>1.Rochette提出可以在前牙区使用树脂水门汀粘接双端金属烤瓷RBFDPS(钉洞)<br>2.美国马里兰大学的Livaditis和Thompson大力推进金属烤瓷RBFDPS的应用（马里兰桥就是这么来的）<br>3.电解蚀刻技术的发展再次促进金属烤瓷RBFDPS的应用（原来钉洞固位）<br>4.含磷酸盐单体树脂水门汀的诞生又一次促进金属烤瓷RBFDPS的应用（化学粘接）<br>第三节 双端RBFDPS使用中的问题<br>1.单侧翼易脱粘接<br>2.基牙易出现继发龋<br>第四节 双端RBFDPS脱位原因分析<br>1.适应证选择不当<br>2.临床制备流程不当<br>3.粘接方式不当<br>4.功能负荷时金属翼刚度不足变形<br>5.基牙不同步的生理运动<br>第五节 双端RBFDPS脱位的处理方案<br>1.不去除双端桥<br>2.只去除脱粘接的翼<br>第六节 单端RBFDPS设计的优势<br>1.牙体预备量较双端的少<br>2.加工制作简单<br>3.脱粘接可及时发现<br>4.美观容易清洁（牙线使用）<br>5.力学分析更加合理（与粘接牙齿动度一致）<br>第三部分 单端RBFDPS的临床适应症<br>第一节 中切牙或侧切牙缺失<br>要求：<br>1.缺失侧至少有一个邻牙牙体牙周是健康<br>2.充足的釉质粘接面积<br>3.有足够的固位翼和连接体空间<br>第二节 发育阶段的儿童和青少年患者<br>1.先天缺失<br>a.上颌侧切牙1.5-1.8%<br>b.女性多于男性<br>2.外伤折断导致<br>a.14岁以下常见<br>b.男性26%女性18%<br>c.外伤导致缺失率约7%<br>第三节生长发育阶段切牙不建议种植的分析<br>1.即使尖牙和牙弓发育完成牙槽嵴仍有垂直方向生长的潜力<br>2.17-18岁的青少年每年有0.1-0.2mm的生长<br>3.青少年过早做种植会导致切缘不一致<br>4.20-25岁仍有潜力<br>5.25岁后进行种植修复是合理的选择（看来不是我以为的18啊！）<br>第四节  青少年切牙缺失正畸关闭或移位的可能性<br>1.可考虑将尖牙通过矫正技术移至侧切牙的位置<br>2.形态和颜色不佳美观度差<br>3.考虑尖牙移位的问题也可移植前磨牙到侧切牙的位置。<br>第五节 青少年切牙缺失RBFDPS修复的优势分析<br>1.疗程短制作容易<br>2.不干扰牙弓的发育<br>3.未来可以正畸治疗及种植修复<br>4.种植医生认为不种植骨吸收目前没有定论<br>5.是否骨吸收取决于桥体的设计。<br>第六节 特殊情况的处理方案<br>1.粘接固位翼的区域有少量树脂<br>2.缺牙间隙过大（正畸）或过小（直接修复）<br>3.深覆颌无舌侧间隙可考虑术前正畸<br>4.缺失两颗牙的可以考虑2个RBFDPS<br>5.3-4颗牙可考虑双端RBFDPS。<br>第四部分 RBFDPS的临床禁忌症及处理方案<br>第一节：禁忌症<br>1.上前牙中缝间隙过大<br>2.牙体位置或轴向异常<br>3.牙齿短小有旧修复体或酸蚀症变色等<br>第二节 禁忌症相对的处理方案<br>1.可考虑树脂改型过大的间隙<br>2.正畸优先调整间隙及改变牙齿位置。<br>3.严重变色及粘接不足时考虑传统修复。<br>第五部分 RBFDPS的临床寿命<br>第一节：关于RBFDPS的临床寿命研究<br>1.1980年Metal研究报告双端RBFDPS桥5年87.7%低于传统修复<br>2.单端RBFDPS桥5年存活率97%，10年91%，15年84%与传统修复类似<br>3.18年的临床研究报告证明单端的寿命要好于双端的。<br>4.氧化铝渗透陶瓷单端的10年94%，18年81.8%。<br>第二节 当下对RBFDPS临床寿命的最新认知<br>1.早期RBFDPS的材料使用的为钴铬金属材质易受力发生弹性形变<br>2.早期金属部材料的粘接系统尚未成熟<br>3.当下使用的材料为氧化锆受力不易变形<br>4.氧化锆的粘接已非常成熟（机械+化学）<br>修复体喷砂是无水喷砂。<br>5.原来设计的为双端，当下为单端。<br>第六部分 RBFDPS单端固定桥的优缺点<br>第一节 优点<br>1.牙体制备量少（全冠制备量40-60%单端10%）<br>2.牙体制备只限于牙釉质<br>3.预备终止线位于平龈或龈上<br>4.牙体预备区在比较隐藏的位置<br>5.咬合关系基本未改变基本可不需要临时修复<br>6.费用低于传统修复延期可考虑传统修复<br>第二节 金属单端RBFDPS的缺点<br>1.金属固位翼有弹性受力易变形<br>2.牙体制备时要制备钉洞<br>3.前牙有半透明性舌侧的金属影响光导<br>4.遮色性的水门汀也会无法遮住<br>5.粘接难度较大不同于传统修复体的粘接。<br>6.基牙制备要求精度高<br>第七部分 RBFDPS诊断分析及治疗计划<br>第一节 治疗计划的确定<br>1.适应证和禁忌症的选择<br>2.牙体评估<br>a.牙髓活力<br>b.有无旧充填物及龋坏<br>c.咬合关系是否正常<br>3.牙周评估<br>a.口腔卫生情况<br>b.探诊深度及出血情况<br>c.松动度<br>第二节 术前评估清单<br>1.牙周健康釉质粘接面积要达到30平方毫米<br>2.颌间距离和翼的厚度满足0.7mm<br>3.颌间距离满足连接体高度3mm（对合伸长可调整）<br>4.中切牙的前导尖牙的侧导有天然牙承担<br>5.基牙的形态和美学特性可修复改善（树脂修复）<br>6.缺牙区有合适的宽度恢复桥体的大小<br>7.建议术前先做蜡型再做口内模拟<br>第三节 如何选择基牙<br>1.选择条件比价好的基牙作为桥基牙<br>2.侧切牙缺失时选择中切牙还是尖牙？<br>a.从牙体外形考虑中切牙为最佳<br>b.从连接体空间考虑中切牙为最佳<br>c.从视觉美观性考虑中切牙为最佳<br>d.在前伸牙合时侧切牙与中切牙的运动轨迹一致<br>e.从釉质粘接面积考虑中切牙为最佳。<br>第四节 修复前的治疗<br>1.口腔卫生宣教和清洁<br>2.是否配合正畸治疗<br>a.缺牙间隙大小和分布<br>b.牙齿轴向位置是否调整<br>c.覆颌小于3mm可行<br>d.覆颌小于4-5mm考虑粘接面积和连接体<br>e.小开牙合时可以在固位翼上建立前导<br>f.建议正畸结束后12周再考虑修复保持。</p>
<p>总结：RBFDPS的历史、临床应用、优缺点、适应症、禁忌症、术前评估、基牙选择。</p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的知乎文章地址： <a target="_blank" rel="noopener" href="https://www.zhihu.com/people/zhao-you-min/posts">https://www.zhihu.com/people/zhao-you-min/posts</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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